50% of housemen in Sabah can’t cope, need retraining

This is the sad state of affairs in Sabah, and possibly even in other states in Malaysia. Is it that the workload is suddenly so bad despite the “glut” of housemen or that the housemen can’t cope for various reasons perhaps e.g. being the Strawberry generation or if inadequately trained in sub-standard medical schools.

KOTA KINABALU: About 50 per cent of some 500 housemen in Sabah have to undergo retraining after being found to be unable to cope with work-related stress, while some of them were suffering from depression, according Sabah Health Director Dr Mohd Yusof Ibrahim.
He said the new generation of housemen or medicine graduates undergoing supervised practical experience is not the same as the housemen many years back.
“My personal opinion, the new generation does not having the ability to cope with stress and their field of training, especially those who graduated from overseas, are unable to face the same situation in our country,” he said.
“Under the new system, housemen are only required to work for an average of 60 hours in a five-day week with two days off, which is even better compared to our times when we didn’t have days off,” he told the press after launching the Queen Elizabeth Hospital 1 (QEH1) 8th State Clinical Conference on Sports Medicine.
Yusof said that apart from failing to cope with stress, those trained outside Malaysia experienced culture shock when facing the situations in the country.
Some claimed they are overworked, but most doctors were trained like that in order to be good doctors, he said.
Yusof said that apart from the hospital authorities, parents should explain to their children that working as a doctor is tough as it involves saving lives.
He stressed that the two-year training they received is not enough for the new generation housemen because it is very common to see many of them having to repeat their training before their posting to district hospitals.

7 comments on “50% of housemen in Sabah can’t cope, need retraining”

Lagi on Housemen! HOs today are extremely pampered. I was a HO 13 years ago. I cannot imagine why would a HO gets into depression, commit suicide, etc, etc because of stress? This is unheard of during my time. Never. But workload wise, it is getting much lighter now. HOs are very much protected. Cannot work for more than a certain hours la, working shifts la.. Last time there are lots of back-to-back calls, EOD calls…not getting EODs and back-to-back were already luxuries to us….but fortunately often we have good teamwork among the HOs, you cover me, I cover you kind of thing. That was the only way to survive that time.

hmm… always wonder why people like to compare with “last time…”.
Just a reminder,
10 years ago, smart phone is almost unheard of.
10 years ago, CT coronary angiogram is almost unheard of.
100 years ago, only very rich can own a car
100 years ago, travelling from Perlis to Johor will take a long long time.

100 years ago, most people walk or ride a bicycle for travel purpose, now, why don’t we do the same?

We as human beings should always aim for a better life, less work and maximise the use of available technology.
Always looking back will hinder ourselves and also our nation towards a developed-nation status.

XhX: Those who can’t cope come from various colleges, both local and foreign.
As for the 60-hour work week, most schedules at my hospital is 60-70Hours. However I find many HOs spend more than the scheduled hours in the hospital. Why? Because they can’t finish their duties in the allocated time due to inefficient work habits and poor basic knowledge. This exists in all fields, if you can’t finish your job during your shift, you stay back till you do. What other option do we have? Leave the patients to their own devices? Pass it over to the equally busy ‘other guy’.

Passer: I agree with you totally. We are in 2012, not 1992. So we should aim for better patient care nowadays. It may surprise you, but I don’t keep my HOs in the ward for my personal pleasure. As long as they get the job done and the patient gets better, they can all go home on the dot. But if they are slow and inept, then they stay as long as required to complete their tasks. Fair?

Few facts:
1. Maximal resident (including interns or HO) work hour per week in US is 80 hours (Summary in American Medical Association website – http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/advocacy-policy/resident-work-conditions.page ). It is closely monitored by ACGME (More information about ACGME http://www.acgme.org/acWebsite/newsRoom/newsRm_factSheet.asp).
2. The hot debate of resident work hour per week in US started in 2002. ACGME started limit the resident work hours since July 2003 after multiple publications, especially in NEJM and conducting multiple surveys from different residency programs about the negative impact to patient care with long hours of working. (Ask yourself – Are you comfortable to let a doctor to operate on you after 60-80 hours marathon working? Do you know you have made a mistake that you are not awared due to marathon working? Marathon working does increase work related injuries.)
3. It is still long working hours compared to the residents in Europe (Average 56 hours per week).
4. Oversea training (referred to US) is probably more organized than local training due to close monitoring by ACGME (or else the Residency program will be on probation or losing the accreditation).
5. I can see that training in oversea might be less stressful than local training partially due to the implementation of Electronic Medical Record (EMR) and Computerized Physician Order Entry (CPOE) that reduce the unnecessary scrub work significantly.
6. In addition, most oversea hospitals have phlebotomy team for blood draw and IV access (including PICC line) that eliminating time consuming routines for interns/HO. More time will be spent on clinical skills training and problem solving (It is logical to spend more time on clinical skills training and problem solving rather than spending 1-2 years for blood draw, IV access, PICC line, scrub work etc… – you can learn all these in a week time or less! Perhaps, you will lose your skills when you become a consultant 10-20 years later anyway…)
7. Team work is emphasized in oversea. Multiple studies emphasize team work reduces medical errors and promote peer learning.
8. Finally, better supporting staffs and working environment. Try to imagine that the poor HO or MO with his long sleeves shirt, tie and white coat in KLH ID ward without proper air-conditioning (while our government has the money to build the tallest building!) , I can see his sweat dripping down from his head and soaking his shirt while doing a procedure (just like finishing a Marathon). Sterile technique?
9. Well, I do admire and respect Malaysia-trained doctors who completed their training successfully but I am very sure you (we) can make it better for our next generation!
10. The MOH should consider the above facts; the HO work related stress is multi-factorials!